Overview
Healthcare in Uganda is offered by three main providers: public hospitals, private not for profit hospitals (PNFP), and private hospitals. Most of the PNFP units are faith based health units. Individuals decide where to seek care based on accessibility, affordability and confidence in the institution. The health system was organized into different levels of care to facilitate referrals from the lower units to the tertiary units. The lowest unit is a health center I, then health center II, health center III, health center IV, district hospital, regional referral hospital and finally one national referral hospital (Mulago Hospital Complex). However, this referral system is often not followed as patients and their caretakers decide on the facility to use. The health worker will also use the system depending on their knowledge, expertise or confidence in the units. Healthcare financing is covered by government through provision of free medical services in the public health units. A few individuals have private insurance, mainly in the business sector; but this has many limitations.
What happens if you need to see a doctor?
In order to see a clinician (in this case a healthcare worker, not necessarily a qualified doctor) one has to first decide where to seek care. Factors like distance, cost, and availability of the required service are considered. A person then has to present themselves to the health facility chosen. In public health units (health centers and hospitals), all services are supposed to be free, but it depends on the availability of the tests and medications. Patients may be referred to private facilities for services like tests and medications. For PNFP and private health units, one has to pay a fee to access the services. The PNFP units tend be less costly. In order to see a specialist in public facilities, one has to be referred to at least a district hospital.
Who decides what medicines the doctor prescribes?
The National Drug Authority of Uganda regulates the Practice of Pharmacy and the Manufacture and Trade in drugs and poisons. The National Medical Stores (NMS) stores and supplies medicines to the public health units. The prescriptions in the public health units depend on the supplies from the NMS. The Joint Medical Stores (JMS) supplies mainly PNFPs and other private healthcare providers. Other factors that come into play are the aggressive drug representatives in marketing their products to providers.
Practically, what is it like to live with Type 1 Diabetes in Uganda?
Individuals with type 1 diabetes need access to health care professionals who have been trained in the management of diabetes. They also need regular and adequate supplies of medicines (mainly insulin) and other supplies like syringes, sharps, glucometers and strips etc. They also need a laboratory service for monitoring their HBAIC and other tests. Currently, many of the children diagnosed are enrolled into a program which provides free supplies. These insulin and supplies are mainly supported by Changing Diabetes in Children (a Novonordisk program), which is a partner of the Ministry of Health. This program is at district and referral hospitals, and a few private hospitals. However, this program has set period which will expire in 2017 so the Ministry of Health is currently working on a sustainability plan.
For adults and those above 25 years, their supplies are subsidized by the government (especially insulin) if they go to a public healthcare unit. Often these supplies are insufficient, so they need to pay for them. The usage of Insulin pumps is uncommon across the country. Glucometers, strips and ketone strips are costly and only stocked in big commercial pharmacy outlets, and therefore even if one has the resources, they must travel to big towns to purchase them.
People with type 1 diabetes need to be treated in facilities that have at least a trained health worker. Most of those who have been trained in management of type 1 diabetes are nurses and a few doctors. There are also only four pediatric endocrinologists in the country. Since there are so few trained personnel, it means long waiting times, long queues and long distance travel. For the healthcare workers, it means many hours of work, which calls for multitasking at their units. To see a specialist, one has to be referred to a district hospital. Access to nutritionists, diabetes nurse educators, psychologists, counselors, ophthalmologists for eye care is limited because of the lack of trained personnel in many units. The school administrators are also not that knowledgeable about diabetes and so do not provide adequate support to these children.
What about getting admitted to hospital?
Admission is free in public health units, but the patient needs to be assessed by the health worker, given a hospital number and then sent for admission. At a private health unit, one has to pay a deposit, provide their health insurance card or get preauthorization by their insurance provider before getting admitted.
How does diabetes care vary throughout the country?
Diabetes care in Uganda is variable in several aspects. There are National Clinical Guidelines provided by the Ministry of Health, and many training manuals and practice guidelines that are provided by International Society of Pediatric and Adolescent Diabetologists (ISPAD) that most of the health workers use. However, there are many health care workers who do not have access to these guidelines, and others that have not been trained.
The quality of care, accessibility and affordability of the diabetic supplies depends on your health care provider, availability of medicines, and expertise of the health worker.
A huge thank you to our friends at the Sonia Nabeta Foundation (opens in a new tab) for providing this information.
Last updated 2016
